Jaundice in Pregnancy

Question 1

Tests:

Bedside - 1

Bloods and why?

Imaging - 1

Answer 1

Urine for bile acids - serology

LFTs - looking for biliary tree dysfunction

USS

Question 2

Obstetric cholestasis:

What is cholestasis again?

S+S

How is it diagnosed?

Rx:

• For abnormal clotting screen for both mother and baby when it’s born?
• For symptoms and abnormal LFTs?

How long does it take for this to recover after birth?

Answer 2

A decrease in bile flow due to:

• impaired secretion by hepatocytes
• obstruction of bile flow through intra-or extrahepatic bile ducts.

Pruritis (palm, soles) - worse at night

Vitamin K PO - IM for baby (standard)

Ursodeoxycholic acid

A few days

Question 3

Acute Fatty Liver in Pregnancy - VERY RARE:

S+S

What pregnancy complication is it associated with?

What can develop which could be life-threatening?

Answer 3

Abdo pain 
Jaundice 
Headache 
Vomiting
Thrombocytopenia - a low blood platelet count
Pancreatitis
---
PET
--
Deep jaundice 
Uraemia - raised urea in the blood - look up why?
Severe hypoglycaemia
Clotting disorder 
Coma/death

Question 4

Acute Fatty Liver in Pregnancy:

Where are they managed?

What needs to be corrected?

Answer 4

HDU
ITU

Clotting disorder
Liver and renal failure

Question 5

Hepatitis B:

What should be checked to identify this?

What would be done for the baby at birth? - 2

Answer 5

HB antigen in women with jaundice

Immunoglobulins
Vaccine